SPECIAL PURPOSE EXAMINATION
SPEX® INFORMATION BULLETIN
POST-LICENSURE ASSESSMENT SYSTEM A joint program of the Federation of State Medical Boards of the United States, Inc. and the National Board of Medical Examiners® Copyright © 2008, 2010 by the Federation of State Medical Boards, of the United States, Inc., and the National Board of Medical Examiners® (NBME®). All rights reserved.
TABLE OF CONTENTS SPECIAL PURPOSE EXAMINATION (SPEX)
Introduction .......................................................................................... 4 Purpose ................................................................................................ 4 Development ....................................................................................... 4
APPLICATION INFORMATION Methods of Application ........................................................................... 5 Eligibility .............................................................................................. 5 Application Procedures, Fees, and Refunds ................................................ 6 Examinees with Documented Disabilities ................................................... 6 Examinees Who Require Personal Items in the Testing Room ....................... 6
SCHEDULING
Test Centers ......................................................................................... 7 Eligibility Period ..................................................................................... 7 Scheduling Permit .................................................................................. 8 Scheduling a Test Date ........................................................................... 8 Rescheduling/Canceling .......................................................................... 9
EXAMINATION ADMINISTRATION
Examination Description ......................................................................... 9 Examination Design ............................................................................. 10 Disease Categories .............................................................................. 10 Physician Tasks ................................................................................... 10 Applying Scientific Concepts .................................................................. 10 Formulating a Diagnosis ....................................................................... 11 Managing Patient Care ......................................................................... 11 Preparation for the Examination ............................................................. 11 Multiple Choice Questions ..................................................................... 12
MULTIPLE-CHOICE ITEM TYPES USED IN SPEX
One Best Answer—Single Item or Multiple Item Set .................................. 12 Example Single Item MCQ Format .......................................................... 13 Example Multiple Item MCQ Format ......................................................... 13
TESTING
Testing Conditions ............................................................................... 14 Testing Regulations and Rules of Conduct ............................................... 14 Rules of Conduct ................................................................................. 15 Personal Belongings ............................................................................. 15 Admission to the Examination............................................................... 16 Completing the Examination ................................................................. 17 Break Time ........................................................................................ 17 Irregular Behavior .............................................................................. 18 Validity of Scores ................................................................................ 19
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SCORING
Computation ...................................................................................... Minimum Pass Recommendation ........................................................... Score Reporting.................................................................................. Score Rechecks .................................................................................. Performance Profiles ........................................................................... Reexamination Procedures ...................................................................
GENERAL INQUIRIES
20 21 21 22 22 22
Inquiries regarding the SPEX program ................................................... 23
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SPECIAL PURPOSE EXAMINATION (SPEX) INTRODUCTION The SPEX is one of two programs available through the Post-Licensure Assessment System (PLAS), a collaborative initiative established in 1998 by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) to provide services for use by medical licensing authorities in assessing a licensed or previously licensed physician’s aspects of competency to practice medicine. The PLAS and its programs are governed through a jointly appointed Governing Committee consisting of representatives from the FSMB and the NBME. In the United States and its territories, licensure to practice medicine is a privilege granted only by the individual medical licensing authorities (state medical boards) of the various jurisdictions. Each state medical board establishes its own rules and regulations and may require, as part of its licensure process, successful demonstration of current competence to practice medicine. The SPEX is used by state medical boards to re-examine a licensed or previously licensed physician’s ongoing level of basic medical knowledge. Situations in which a medical licensing board may require a physician to take SPEX include endorsement of licensure, reinstatement or reactivation of a license after a period of inactivity (due to illness, disciplinary action, etc.). In instances where the state medical board has or is aware of concerns and/or questions about a physician’s fitness to practice, the results of the SPEX exam should be evaluated in conjunction with other available evidence to determine a physician’s competence and fitness to practice.
PURPOSE The SPEX is designed to assess the ability to apply, at a minimally acceptable level, the general medical knowledge considered essential for continued, unsupervised practice by physicians who hold or have held a valid, unrestricted license in a United States or Canadian jurisdiction.
DEVELOPMENT Development of the SPEX examination materials has been accomplished through committees of medical experts appointed by, and working in collaboration with, the FSMB and the NBME. Members of such committees are selected for their expertise in their respective fields and are drawn from the academic, practice, and licensing communities. All of the test materials used in the SPEX are jointly owned by the parent organizations, the FSMB and the NBME, and are copyrighted by the NBME. Any reproduction or distribution of these test materials without express written authorization of the NBME is prohibited.
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Development and regulation of policies and procedures necessary for implementation of the SPEX are the responsibility of the PLAS Program Committees. Members of the PLAS Program Committees include highly qualified physicians from the academic and licensing communities who have experience in clinical settings.
APPLICATION INFORMATION METHODS OF APPLICATION There are two methods of application for taking the SPEX: board-sponsored or selfnominated. Board-sponsored candidates take the examination at the request and approval of a medical licensing board to demonstrate current medical knowledge. If you take the SPEX through the board-sponsored process, the examination score will be reported to you and the board for which the SPEX is being taken. Self-nominated candidates take the SPEX independent of any request or approval from a medical licensing board. If you take the SPEX through the self-nominated process, the examination score will be reported only to you. The FSMB will maintain the score in its database, and the score will be made available to medical licensing boards upon your request and completion of an Examination and Board Action History Report (EBAHR) form and payment of appropriate fee.
ELIGIBILITY Eligibility requirements for admission to the SPEX are dependent on your method of application. Board-sponsored: To be eligible to take the examination through the boardsponsored process, you must have held a valid, unrestricted license in a United States or Canadian jurisdiction and otherwise have met eligibility requirements established by the individual licensing boards pursuant to their statutory and regulatory provisions. If you wish to take the examination as a board-sponsored candidate, you should contact either the licensing authority from which you hold a license, or the licensing authority from which you plan to seek a license, to determine your eligibility according to the requirements of the jurisdiction. Self-nominated: To be eligible to take the examination through the self-nominated process, you must have a current, unrestricted license to practice medicine in a United States or Canadian jurisdiction. You must submit a copy of your medical license with the application.
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APPLICATION PROCEDURES, FEES, AND REFUNDS Application procedures, fees, and refund policies vary among licensing boards. To assist you, the FSMB maintains complete information for all licensing boards. You may contact the FSMB at 817-868-4041. The FSMB will make available relevant application information for board-sponsored and self-nominated applicants. SPEX application materials provide detailed information on procedures, fees, and refunds. Changes in the SPEX program may occur after the release of this bulletin. If changes occur, information will be posted at the FSMB’s website, www.fsmb.org. You must obtain the most recent information to ensure an accurate understanding of current SPEX rules.
EXAMINEES WITH DOCUMENTED DISABILITIES Reasonable accommodations are provided to examinees with documented disabilities as defined by the Americans with Disabilities Act as amended in 2008, together (“ADA”). If you are a disabled individual covered under the ADA and require test accommodations, you must obtain information on the procedures and documentation requirements via the FSMB website or by contacting the FSMB. Documentation will be required to substantiate a request for accommodation. If approved, special arrangements and procedures will be established and communicated to you by the FSMB. Your application, together with your request for accommodations and accompanying documentation must be submitted to the appropriate addresses. All documentation received with your request will be considered in the review process and you will be contacted if additional information is needed. Processing may take up to eight weeks from the date sufficient documentation is received. When test accommodations are granted, score reports and transcripts may include an annotation that the accommodation was granted. Score recipients who inquire about the annotation will be provided with information about the nature of the accommodation only.
EXAMINEES WHO REQUIRE PERSONAL ITEMS IN THE TESTING ROOM Unauthorized possession of personal items while you are in the secure areas of the testing center is prohibited. However, in certain limited circumstances, exceptions to this policy may be made for medical reasons, provided that permission is granted in advance of test administration. If you believe that you have a medical condition that requires you to use medication, an external appliance, or electronic device in the secure areas of the test center, please submit a written request via email to
[email protected] or via mail to Attn: Coordinator, Special Examination Services Federation of State Medical Boards, 400 Fuller Wiser Road, Suite 300, Euless, TX, 76039 at least four weeks prior to your anticipated test date.
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You will need to explain the necessity for the exception and provide documentation from your medical professional substantiating your need to use the item(s) during test administration. Examples of appliances and devices to which this policy applies include insulin pumps, inhalers, medications, TENS units, breast pumps, hearing aids, wheelchairs, canes, crutches and casts. This list is not exhaustive; if you are unsure whether you should request an exception, please contact the Coordinator for Special Examination Services via email at
[email protected]. You are not required to obtain advance permission to wear eyeglasses or contact lenses during testing, or to consume food or medication on authorized breaks. All personal items, including those permitted as an exception under this policy, are subject to inspection at the test center. If you bring an item, including an appliance or device, to your test administration without obtaining permission in advance, you may not be permitted to test, you may be required to relinquish the item, you may be investigated for irregular behavior, and/or your score may be held until you provide adequate documentation from your medical professional.
SCHEDULING TEST CENTERS The SPEX is administered at Prometric Testing Centers network of more than 300 testing centers. Centers are located throughout the United States, Canada, Puerto Rico, and the Virgin Islands. Test center locations can be found on Prometric’s website at www.prometric.com. You will be provided with a scheduling permit, which provides a toll-free number and instructions for scheduling at a location of your choice. You will be provided a 90-day eligibility period in which to take the examination.
ELIGIBILITY PERIOD SPEX eligibility periods are assigned immediately once your application has been processed and approved. It takes approximately two weeks to process an application. Upon complete processing of your SPEX application and confirmation of eligibility, a Scheduling Permit will be sent to you with instructions for making an appointment at a Prometric Test Center. On receipt of your Scheduling Permit, you should contact Prometric immediately to schedule the test date. The Scheduling Permit specifies the eligibility period (beginning immediately and extending for approximately 90 calendar days) during which you must complete the examination. If you do not take the test within your eligibility period, you are no longer eligible and must submit a new application, including the full fee and supporting documentation. The SPEX fee is not transferable from one application to another.
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SCHEDULING PERMIT Your Scheduling Permit will be sent to you when the processing of your application is complete. You should verify the information on your Scheduling Permit before scheduling your appointment. Your Scheduling Permit includes the following: • your name (see Important Note, page 16) and mailing address; • the examination for which you registered; • your eligibility period; • your Scheduling Number; and • your Candidate Identification Number (CIN) Note: You will not be able to take the test if you do not bring your Scheduling Permit to the test center. Please keep it in a secure location. If you lose your permit, contact the FSMB immediately. You may be required to reschedule your appointment. Note: Your Scheduling Number is needed when you contact Prometric to schedule a test date. It differs from your Candidate Identification Number (CIN), which is your private key and is needed to test. Prometric does not have access to your CIN.
SCHEDULING A TEST DATE When scheduling a test date, please keep the following in mind: • You must have your Scheduling Permit before you contact Prometric to schedule a testing appointment. Appointments are assigned on a "first-come, first-served" basis; therefore, you should contact Prometric to schedule as soon as possible after you have received your Scheduling Permit. • You may take the test on any day that it is offered during your assigned eligibility period, provided that there is space at the Prometric Test Center you choose. • Prometric Test Centers are closed on major local holidays. • The busiest testing times in the Prometric testing network are May through July and November through December. Your Scheduling Permit includes specific information for contacting Prometric to schedule your test date at the test center of your choice. You will be required to provide information found only on your Scheduling Permit. When you schedule your appointment, you will receive the following specific information: • the confirmed test day, date, and time; • the address and telephone number of the Prometric Test Center where you will test; and • your Prometric Confirmation Number.
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RESCHEDULING/CANCELING If you are unable to keep your testing appointment on the scheduled date or at the scheduled location, you may change your date or center by following the instructions on your Scheduling Permit for contacting Prometric. To avoid a rescheduling fee, you must cancel or reschedule your appointment at least five business days before your scheduled test date. You will need to provide your Prometric Confirmation Number when you reschedule. Your rescheduled test date must fall within your assigned eligibility period. Rescheduling or cancellations must be made and confirmed by direct contact with Prometric; leaving a message on a recorder or by voice mail is not sufficient to confirm these changes. If you do not cancel your examination testing session per Prometric’s procedures, you will be required to pay additional fees directly to Prometric in order to reschedule an examination testing session within the 90-day eligibility deadline. Prometric rescheduling fees will also apply if you need to reschedule because you do not provide adequate identification at the time of admission to your testing session, or you arrive too late to begin the examination without disrupting the test center’s schedule. If you schedule an examination testing session with Prometric within the 90-day eligibility period but do not take the SPEX and do not cancel with Prometric, you will forfeit the entire fee. You will not be allowed to reschedule beyond your eligibility deadline. To reapply for the SPEX, you will be required to submit a new application and fee. If you have followed Prometric’s cancellation procedures, or have never scheduled an examination testing session with Prometric, you are eligible to request a partial refund of your SPEX fee. A request for a refund must be submitted to the FSMB in writing.
EXAMINATION ADMINISTRATION EXAMINATION DESCRIPTION The SPEX is a one-day, computer-administered examination consisting of 7 blocks of 64 minutes each (48 questions in each block). The test items used in the SPEX focus on a core of clinical knowledge and relevant, underlying scientific principles deemed necessary to form a reasonable foundation for the safe and effective practice of medicine. SPEX content is intended to reflect the knowledge and cognitive abilities of practicing physicians.
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EXAMINATION DESIGN The content of the SPEX is structured along two primary dimensions: disease categories and physician tasks. These are integrated in constructing the exam and are described below.
DISEASE CATEGORIES The principal organizing dimension of the SPEX design is a list of disease categories, within which individual diseases/disorders are identified. These individual diseases/disorders are derived from a model of practice for USMLE and are sampled from the categories listed below. These categories and content coverage are subject to change. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.
General Principles Disorders of Blood Disorders of the Nervous System/Special Senses Mental Disorders Disorders of the Skin Disorders of the Musculoskeletal System Disorders of the Respiratory System Cardiovascular Disorders Gastrointestinal Disorders Renal and Urinary Disorders Disorders of the Male Reproductive System Female Reproductive System and Pregnancy Disorders of the Endocrine System Immunologic Disorders
PHYSICIAN TASKS A second organizing dimension of the SPEX comprises the actions taken by physicians in clinical practice. These are structured as competency-based objectives. Physicians should be able to apply scientific concepts, formulate a diagnosis, and manage patient care.
APPLYING SCIENTIFIC CONCEPTS Objectives focus on identifying the underlying processes or pathways responsible for a given condition, recognizing associated disease conditions and complications, and recognizing and evaluating clinical findings or diagnostic studies to identify the underlying factors (e.g., anatomic structure).
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FORMULATING A DIAGNOSIS History and Physical Examination objectives focus on interpreting the patient’s history, knowing pertinent factors in the patient’s history, interpreting the history in terms of risk factors for the patient, recognizing and interpreting pertinent physical findings, and knowing required techniques in the physical examination. Laboratory and Diagnostic Studies objectives focus on selecting the appropriate routine, initial, invasive, special, or follow-up studies; interpreting the results of laboratory or diagnostic tests; knowing the value of and indications for screening tests; and predicting the most likely test result. Diagnosis objectives focus on selecting the most likely diagnosis in light of history, physical examination, or diagnostic test findings; includes interpreting pictorial material and establishing a diagnosis. Prognosis objectives focus on interpreting the vignette, evaluating the severity of the patient’s condition, and making judgment on the current status or prognosis of the patient as to the need for further action.
MANAGING PATIENT CARE Health Maintenance objectives focus on identifying risk factors, knowing incidence within patient groups at risk, knowing preliminary steps to ensure effectiveness of intended therapy, and selecting appropriate preventive therapeutic agents or techniques. Clinical Intervention objectives focus on knowing priorities in emergency management; knowing present and long-term management of selected conditions; and knowing appropriate surgical treatment, including pre- and post-surgical events. They also include knowing pre- and post-procedural management and the appropriate follow-up schedule or monitoring approach. Clinical Therapeutics objectives focus on selecting the appropriate pharmacotherapy, recognizing actions of drugs as applied to patient management, and knowing the importance of educating patients about effects of drugs and drugdrug interactions. Legal/ethical and health care systems objectives focus on issues such as patient autonomy, physician/patient relationships, use of unorthodox or experimental therapies, end-of-life considerations, treatment of minors, and physician error versus negligence.
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PREPARATION FOR THE EXAMINATION The most appropriate preparation for the SPEX is a well-planned and comprehensive review of up-to-date medical textbooks, clinical review publications, and periodicals. A web-based “self-assessment” – the Comprehensive Clinical Medicine Self-Assessment (CCMSA) – is also available. The CCMSA uses information typically covered in clinical encounters, and the content of the items resembles the content in SPEX. The CCMSA will help you become familiar with the question formats used in the examination and with how to maneuver within the examination before your actual test date. The CCMSA is available on the NBME website at: https://nsas.nbme.org/nsasweb/servlet/mesa main There are no test preparation courses affiliated with, or sanctioned by, the PLAS program.
MULTIPLE CHOICE QUESTIONS There is one basic item type used for the multiple-choice questions (MCQs) in SPEX. It is the One Best Answer—Single Item type. On occasion, a second or third item may be connected in a multiple item set. These are always one best choice as well.
MULTIPLE-CHOICE ITEM TYPES USED IN SPEX The items used in the SPEX will not have exactly the same appearance as the sample items provided in this section. However, these sample items should give you a sense of the general item format used in the SPEX.
ONE BEST ANSWER—SINGLE ITEM OR MULTIPLE ITEM SET This is the traditional, most frequently used multiple-choice format. It consists of a statement or question followed by four or five response options. In the SPEX, the options in this item type are always lettered, i.e., A, B, C, D, E. You are required to select the best answer to the item. Options other than the single best (correct) answer may be partially correct, but there is only one best answer to this item type. DIRECTIONS: Each of the numbered items below is followed by answers lettered A, B, C, D, E. Select the ONE lettered answer that is BEST in each item.
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Example Single Item MCQ Format: 1. A 45-year-old African-American man comes to the office for the first time because he says, "I had blood in my urine when I went to the bathroom this morning." He reports no other symptoms. On physical examination his kidneys are palpable bilaterally and he has mild hypertension. Specific additional history should be obtained regarding which of the following? A. B. C. D. E.
Chronic use of analgesics Cigarette smoking Family history of renal disease Occupational exposure to carbon tetrachloride Recent sore throats
(Answer C) Example Multiple Item MCQ Format: A 38-year-old white woman, who is a part-time teacher and the mother of three children, comes to the office for evaluation of hypertension. You have been her physician since the birth of her first child 8 years ago. One week ago, an elevated blood pressure was detected during a regularly scheduled examination for entrance into graduate school. Vital signs on examination today are temperature 37.0 C (98.6 F), pulse 100/min, respirations 22/min, and blood pressure 164/100 mm Hg (right arm, supine). 2. The physical examination is most likely to show which of the following? A. B. C. D. E.
An abdominal bruit Cardiac enlargement Decreased femoral pulses Thyroid enlargement Normal retinas
(Answer E) 3. To assess this patient's risk factors for atherogenesis, the most appropriate test is determination of which of the following? A. B. C. D. E.
Plasma renin activity Serum cholesterol concentration Serum triglycerides concentration Urinary aldosterone excretion Urinary metanephrine excretion
(Answer B) End of Set
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TESTING TESTING CONDITIONS The FSMB and the NBME have established strict criteria for the security, accessibility, and general comfort of computer-based testing centers. These criteria are intended to ensure that no examinee or group of examinees receives unfair advantage on the examination, inadvertently or otherwise. Efforts are made to ensure that the examinations are administered under standard conditions and in conformity with the principles on which the examination and its scoring are founded. If there is a reason to believe that the integrity of the examination process is jeopardized, the SPEX parent organizations may invalidate all or any part of an examination. If information indicates that continued testing would jeopardize the security of examination materials or the integrity of scores, the SPEX parent organizations reserve the right to suspend or cancel test administration. The identity of each examinee is verified before admission to the examination room. To be admitted to the examination, you must have your Scheduling Permit and an unexpired, government-issued identification form such as a driver’s license or passport that includes both a photograph and a signature. You will be required to sign in at the test center. A photo of you will be taken at the center. This administration-day photo becomes part of your SPEX record. All examination administrations will be video recorded. If at any time during the examination you believe there is a problem with either the computer equipment or with how the program is functioning, please contact the test center administrator immediately.
TESTING REGULATIONS AND RULES OF CONDUCT The SPEX is a proctored examination. Test center staff monitor all testing sessions for SPEX. You must comply with all directions and instructions provided by the test center administrators throughout the examination. Failure to do so may result in a determination of irregular behavior. Test center staff are not authorized to answer questions from examinees regarding examination content, testing software, or scoring. If staff observe you violating test administration rules or engaging in other forms of irregular behavior during an examination, the center staff will not necessarily tell you of the observation at the time of the examination. Test center staff are required to report such incidents to the PLAS program; each report is fully investigated.
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RULES OF CONDUCT When you apply to take the SPEX, you are agreeing to the following Rules of Conduct: 1. You are the person named on the Scheduling Permit for the examination. 2. You will not give, receive, or obtain any form of unauthorized assistance during the examination or during breaks. 3. You will not have any formulas, study materials, notes, papers, or electronic devices of any kind in your possession while you are in the secure areas of the center. 4. You will place in a locker or cubicle all personal belongings, including (but not limited to) cellular telephones, watches, pagers, personal digital assistants (PDAs), formulas, study materials, notes, papers, and your purse or wallet, before you enter the testing room. 5. You will not leave your testing station for breaks unless the break screen is visible on your monitor. It will be considered a violation of the Rules of Conduct if you indicate on the center log that your break screen is visible when it is not. 6. You may use a telephone or other communication device while outside the secure testing area and only during an authorized break. You may not use it for any purpose related to test content. 7. You will not remove materials in any form (written, printed, recorded, or any other type) from the test center. 8. All examination materials remain the property of the PLAS parent organizations, and you will maintain the confidentiality of the materials. You will not reproduce or attempt to reproduce examination materials through memorization or any other means. Also, you will not provide information relating to examination content that may give or attempt to give unfair advantage to individuals who may be taking the examination. This includes postings regarding examination content and/or answers on the Internet. If you violate these Rules of Conduct, you may be directed to leave the test center before you complete the examination. Also, evidence of violation of any test administration rule, including these Rules of Conduct, will result in actions being taken under PLAS policies and procedures on irregular behavior. If you are found to have engaged in irregular behavior, your score report and transcripts will include this finding, and you may be barred from taking the SPEX in the future.
PERSONAL BELONGINGS Unauthorized possession of personal belongings while in the secure areas of the testing centers may lead to a finding of irregular behavior and permanent annotation of your SPEX transcript.
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Reference materials, i.e., books, notes, papers, or other sources, may not be consulted. You are not permitted to bring personal belongings into the testing area. Unauthorized items include, but are not limited to: • mechanical or electronic devices, such as cellular telephones, personal digital assistants (PDAs), calculators, watches of any type, electronic paging devices, recording or filming devices, radios; • outerwear, such as coats, jackets, head wear, gloves; • book bags, backpacks, handbags, briefcases, wallets; • books, notes, study materials, or scratch paper; and • food, candy, gum, or beverages. If you bring any personal belongings to the test center, you must store them in a designated locker or storage cubicle outside the secure testing area. You should keep in mind that the storage facilities are small and that all stored mechanical or electronic devices must be turned off. Personal items and their contents are subject to inspection. Any materials that reasonably appear to be reproductions of any SPEX examination materials will be confiscated. Making notes of any kind during an examination, except on the materials provided by the test center for this purpose, is not permitted. Removal of those materials from the secure testing area is prohibited.
ADMISSION TO THE EXAMINATION You should arrive at the Prometric Test Center at least 30 minutes before the scheduled testing time on your test day. If you arrive late, you may not be admitted. If you arrive more than 30 minutes after your scheduled testing time, you will not be admitted. In that event, you must pay a fee to Prometric to reschedule your test. Your rescheduled date must fall within your assigned eligibility period. When you arrive at the test center, you must present your SPEX scheduling permit and the required identification described on your Scheduling Permit. Acceptable forms of identification include the following forms of unexpired identification: • passport; • driver’s license with photograph; • national identity card; • other form of unexpired, government-issued identification. Your identification must contain both your signature and photograph. If you do not bring your SPEX Scheduling Permit and acceptable identification, you will not be admitted to the test. In that event, you must pay a fee to reschedule your test. Your rescheduled test date must fall within your eligibility period. Important Note: Your name as it appears on the SPEX Scheduling Permit must match the name on your form(s) of identification exactly. If the name listed on your Scheduling Permit is not correct or does not match your form(s) of identification, contact the FSMB immediately at 817-868-4041. 16
Upon arrival at the test center, you must present the required identification, sign a test center log, be photographed, and store your personal belongings in your assigned locker. Test center staff will collect your Scheduling Permit. You will be instructed to write your Candidate Identification Number (CIN) on one of the laminated writing surfaces provided. Your Scheduling Permit will be retained at the Test Center Administrator’s station. You may request access to the permit during the examination if it becomes necessary for you to rewrite the CIN on the laminated writing surface. In addition to the laminated writing surfaces, you will be provided with dry-erase markers and an eraser. Test center staff will escort you to your assigned testing station and provide brief instructions on use of the computer equipment. You must enter your Candidate Identification Number to start the examination. You may then take a brief tutorial prior to starting the first test block.
COMPLETING THE EXAMINATION The SPEX examination is downloaded from Prometric to the testing center where you are scheduled to take the SPEX. To gain access to the examination, you must enter the unique Scheduling/Candidate ID Number. The examination itself is divided into 7 blocks of 64 minutes each (48 questions in each block). Timing for each section of SPEX is computer-controlled, and a “Time Remaining” box is displayed on the computer screen. You should try to answer every test item as there is no penalty for guessing. You should try to complete every block of the examination. Once you exit a block, you will not be allowed to return to that block. The test session ends when all blocks have been completed (or the total time for the test expires). You will sign out as you leave the test center and receive a test completion notice. If you choose to leave the testing center before completing the exam, the administration will be considered incomplete. An incomplete or partial administration may affect reexamination procedures.
BREAK TIME Your entire testing session is scheduled for a fixed amount of time. The computer keeps track of your overall time and the time allocated for each block of the test. A “Time Remaining” box is displayed on the computer screen. Forty-five minutes is allotted for break time. The 45 minutes for breaks can be divided in any manner, according to your preference. For example, you can take a short break at your seat after you complete a block, or you can take a longer break for a meal outside the test center after you complete a few blocks. If you complete a block of the test or tutorial section early, the remaining time will be available for breaks. It will not be available to complete other blocks of the test.
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As you progress through the blocks of the test, you should monitor how many blocks are remaining and how much break time is remaining. If you take too much break time and exceed the allocated or accumulated break time, your time to complete the last block(s) in the testing session will be reduced. When section time runs out, you will not be able to move to any new screens. The computer will close the section. After you complete or run out of time for each block during the test, you must respond when the computer asks you to indicate whether you want to take a break or continue. After your test, you may be asked to complete an additional block that contains survey questions about your testing experience.
IRREGULAR BEHAVIOR Irregular behavior includes any action by applicants, examinees, potential applicants, or others when solicited by an applicant and/or examinee that subverts or attempts to subvert the examination process. If you have information or evidence indicating that any type of irregular behavior or any infringement of legal rights has occurred, you should submit a written report to or telephone the PLAS Secretariat at the following address: PLAS Secretariat FSMB 400 Fuller-Wiser Road, Suite 300 Euless, TX 76039 817-868-4041 Specific examples of irregular behavior include, but are not limited to, the following: • seeking and/or obtaining unauthorized access to examination materials; • providing false information or making false statements on or in connection with application forms, Scheduling Permits, or other SPEX-related documents; • taking an examination without being eligible for it or attempting to do so; • impersonating an examinee or engaging someone else to take the examination for you; • giving, receiving, or obtaining unauthorized assistance during the examination or attempting to do so; • making notes of any kind while in the secure areas of the test center except on the writing materials provided at the test center for this purpose; • failing to adhere to any PLAS policy, procedure, or rule, including instructions of the test center staff; • verbal or physical harassment of test center staff or other disruptive or unprofessional behavior at a test center; • possessing any unauthorized materials, including photographic equipment, or communication or recording devices, including electronic paging devices and cellular telephones, in the secure testing areas; • altering or misrepresenting examination scores; 18
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any unauthorized reproduction by any means, including reconstruction through memorization, and/or dissemination of copyrighted examination materials by any means, including the Internet; and communicating or attempting to communicate about specific test items, cases, and/or answers with another examinee, potential examinee, or formal or informal test preparation group at any time before, during, or after the examination.
Note: Discussion of examination content or answers on the Internet may also result in a determination of irregular behavior. If information received suggests that irregular behavior has occurred, statistical analyses may be conducted and additional information may be gathered. You will be advised of the alleged irregular behavior, and you will have an opportunity to provide information that you consider relevant to the evaluation of the allegation. Your scores may be withheld, if they have not been reported previously. Applications may not be processed, and you may not be permitted to take subsequent examinations until a final decision regarding irregular behavior is made. You will be provided with a copy of the PLAS Special Purpose Examination Policies and Procedures Regarding Irregular Behavior, which describes in detail the process for reaching final decisions regarding irregular behavior. If the evidence suggests that the alleged irregular behavior affects score validity, the score will also be reviewed as described below. If it is determined that you engaged in irregular behavior, information regarding this determination becomes part of your SPEX record. Your score report (if applicable) and SPEX transcript will contain a notation regarding the irregular behavior. Information about the irregular behavior will be provided to third parties that receive or have received your SPEX transcript. Such information may also be provided to other legitimately interested entities. If it is determined that the irregular behavior is egregious and/or threatens the integrity of the examination system, you may be barred from future SPEX examinations. The PLAS program reserves the right to bar an individual from the SPEX or to have special test administration procedures implemented when information regarding behavior of examinees on the SPEX indicates such actions may be necessary to ensure the security of the SPEX.
VALIDITY OF SCORES The PLAS program assures the validity of scores reported for SPEX examinations by every means available. Your scores may be classified as indeterminate if the scores are at or above the passing level and the PLAS program cannot certify that they represent a valid measure of your knowledge or competence as sampled by the examination. The PLAS program may make such a determination when aberrancies in performance are detected for which there is no reasonable and satisfactory 19
explanation. A classification of indeterminate may result from irregular behavior (see previous section) or from other factors, such as unexplained inconsistency in performance within an administration of the SPEX or between takes of the SPEX. The performance of all examinees is monitored and may be analyzed statistically to detect aberrancies indicating that your scores may be indeterminate. In addition, evidence of irregular behavior may suggest that your scores do not represent a valid measure of your knowledge or competence as sampled by the examination. In these circumstances, your score report may be delayed, pending completion of further analysis and investigation. If your score report is delayed, you and any other party to whom scores would normally be reported will be notified. You will be provided with a copy of the PLAS Special Purpose Examination Policies and Procedures Regarding Indeterminate Scores, which describes the process for reaching final decisions. You will have an opportunity to provide information that you consider relevant. After review and analysis of all available information, scores will be classified as valid and will be reported, or scores will be classified as indeterminate. If the scores are classified as indeterminate, you will be advised of the options for retaking the examination. Scores classified as indeterminate do not appear on your transcript; rather, an annotation indicates that the scores were classified as indeterminate. Scores classified as indeterminate will not be reported to anyone. Anyone who has received a report of scores that are later classified as indeterminate will be notified of the indeterminate classification. The PLAS Special Purpose Examination Policies and Procedures Regarding Indeterminate Scores describes the circumstances in which information about the indeterminate classification will be provided to entities that receive or have received your SPEX transcript. If irregular behavior appears to have contributed to a decision that your scores are indeterminate, action will also be taken as described above.
SCORING COMPUTATION Your responses are electronically forwarded directly to the scoring center. Raw scores (number of questions answered correctly) are determined and then converted to a two-digit scaled score for reporting purposes. To receive a score, you must complete the entire exam. A complete examination is one in which all blocks have been accessed and the examinee either exits the examination or runs out of time. If you begin but do not complete the SPEX, no scores are reported, and an “incomplete” annotation will appear on applicable SPEX transcripts. Therefore, it is essential that you remain at the testing center for all blocks of the SPEX. Scores are truncated to a whole number, i.e., all decimal places are dropped. If you register for but do not take the SPEX, no record of the test will appear on a transcript.
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MINIMUM PASS RECOMMENDATION The SPEX Program Committee recommends 75 as the minimum passing score for the SPEX. Medical licensing authorities may accept the recommended pass/fail result, or they may establish their own passing score. Recommended performance standards for the SPEX are based on a specified level of proficiency. As a result, no predetermined percentage of examinees will pass or fail the examination. The recommended minimum passing level is reviewed periodically and may be adjusted at any time. It should be noted that the reported score of 75 is NOT “75%” but a value on a scale that meets the requirements of licensing board statutes and regulations.
SCORE REPORTING SPEX scores are released approximately two to four weeks following a test administration. For board-sponsored examinees, these scores will be reported to the state licensing board as well as to the examinee. In some instances, examinee scores are mailed to the licensing board and the licensing board forwards the score results to the examinee. For self-nominated examinees, a score report will be sent only to the examinee. No score information will be provided via telephone, fax, or email. Any anticipated delay in score reporting due to activities by the SPEX program will be announced on the FSMB website at: www.fsmb.org. The FSMB maintains a computerized databank of all SPEX scores to facilitate endorsement among jurisdictions. You may request that certified transcripts of your SPEX scores be forwarded to other licensing boards from which you are seeking licensure, to other appropriate credentialing agencies or organizations, or to yourself. Requests must be made on an Examination and Board Action History Report (EBAHR) form and be accompanied by the requisite fee. Forms may be obtained from the FSMB and from the FSMB’s website, www.fsmb.org. If you do not receive your original score report, a request for a duplicate score report will be honored up to 90 days after your score report release date. You must make your request in writing to the FSMB. If more than 90 days have passed since your score report release date, scores will be reported to you only in the form of a SPEX transcript after you submit a signed EBAHR form and pay the required fee. Examination data (including score information) from the SPEX may be used or made available to third parties for use in appropriate research projects. In such instances, the data will be treated as confidential and individual examinees will not be identified or identifiable in any documentation of or publication relating to any such research project.
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SCORE RECHECKS Standard quality assurance procedures ensure that the scores reported for each examinee are an accurate reflection of the responses recorded by the computer. A change in score based on a re-check is an extremely remote possibility. However, a score recheck may be requested in writing and submitted to the FSMB along with the required processing fee. Your request must be received by the FSMB no later than 90 days after your score was released. Score recheck requests and a check or money order for the fee made payable to the FSMB should be mailed to: SPEX Rescores FSMB 400 Fuller-Wiser Road, Suite 300 Euless, TX 76039
PERFORMANCE PROFILES As part of your score report, you receive a graphical presentation that summarizes areas of relative strength and weakness. These profiles are developed as selfassessment tools for the use of examinees. For a more detailed description of the content areas represented by the profiles, refer to the Examination Design section of the SPEX Bulletin.
REEXAMINATION PROCEDURES The computerization of the SPEX allows licensing boards and physicians to access the examination more often because there are no specific, predetermined administration dates. A self-nominated examinee is limited to 3 attempts within a 12 month period. The examinee may retake an exam after the initial attempt with no waiting period and submission of a new application and fee. A third attempt requires a mandatory 90-day waiting period from the previous attempt. Any subsequent attempts require a one-year waiting period from the initial attempt. Board-sponsored examinees, at the sponsoring board’s discretion, may not be subject to the same waiting periods. Any additional reexamination eligibility requirements and procedures for unsuccessful examinees are established by the individual licensing boards, pursuant to the boards’ statutes and regulations. NOTE: The SPEX program considers the latest score achieved by an examinee to be the “official score” for the respective examination and has made recommendations to this effect to the individual licensing boards. However, the individual licensing boards are ultimately responsible for determining what scores within an examinee’s history meet the board’s examination requirements for licensure. Certified transcripts of SPEX scores provided to the licensing boards by the FSMB list all SPEX scores achieved for a given examinee.
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GENERAL INQUIRIES Inquiries regarding the SPEX program can be directed to: SPEX Federation of State Medical Boards 400 Fuller-Wiser Road, suite 300 Euless, TX 76039 817-868-4041
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